The Use of Pasteurized Donor Human Milk in Healthy Newborns and Lactation Outcomes After Hospital Discharge in the United States: An Integrative Review

Abstract

Background:

Pasteurized donor human milk (PDHM) is frequently used to supplement healthy, breastfeeding newborns in birth hospitals, with varied practices and limited postdischarge outcomes. This review examines the use of PDHM supplementation in healthy, noncritically ill newborns cared for in postpartum units and level 1 nurseries and aims to understand its effects on lactation after hospital discharge.

Methods:

We conducted an integrative review of both qualitative and quantitative studies that were conducted in the United States, in English, and reported the use of PDHM in healthy or noncritically ill infants, and where the primary setting was a mother–baby unit or level 1 nursery. Data sources included PubMed, CINAHL, Scopus, Web of Science, Embase, Emcare, and the Maternity and Infant Care Database. We included 18 articles published between 2014 and 2025 in the final review. Common characteristics were categorized, quantified, and compared across the studies.

Results:

Inductively derived categories are as follows: (1) indication for PDHM supplementation, (2) hospital-level characteristics, (3) breastfeeding outcomes, (4) maternal and infant demographic and socioeconomic characteristics, and (5) opinions on the use of PDHM when reported from clinical and patient perspectives. In addition, we specifically examined each article for examples of the protection of milk supply (interventions to support lactation and/or pumping recommendations).

Conclusions:

PDHM is preferable to formula for supplementation and has been associated with improved breastfeeding outcomes. However, evidence suggested that supplementation without interventions to protect milk supply may pose a risk to breastfeeding after discharge.

Keywords

establishing milk supply pasteurized donor human milk human milk breastfeeding postpartum lactation supplementation

Introduction

The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF)¹ and the American Academy of Pediatrics (AAP)² recommend an exclusive human milk diet for the first 6 months of life and continued breastfeeding along with complementary feedings until age 2 years or beyond. Yet, in the United States, breastfeeding rates are persistently suboptimal. According to the Centers for Disease Control and Prevention, in 2022, 85.7% of infants were breastfed at birth, but only 27.9% of infants received an exclusive human milk diet by age 6 months.³

Human milk and breastfeeding have short- and long-term health benefits for infants and women. Infants who are breastfed have a reduced risk of mortality and common childhood infections such as otitis media, gastrointestinal and respiratory illnesses, including respiratory syncytial virus, and a reduced risk of chronic diseases, including type 1 and type 2 diabetes, obesity, and leukemia.⁴ Evidence also supports an association with breastfeeding and higher intelligence scores in children later in life.⁵ Women who breastfeed have a lower risk of developing type 2 diabetes, hypertension, and cancers, including breast, ovarian, endometrial, and thyroid cancers.⁴

Many benefits of breastfeeding are dose-dependent and enhanced when breastfeeding is done exclusively and for an extended duration.⁴ Duration and exclusivity of breastfeeding are associated with the timely onset of a copious milk supply brought on by secretory activation.^6,7 This stage of milk production, which typically occurs 2–4 days after birth, requires frequent and effective removal of milk from the breast.^4,7

When a woman is unable to provide human milk due to maternal or infant illness or separation from the infant, pasteurized donor human milk (PDHM) is preferred over formula for infant feeding supplementation.^1,4 Although PDHM was initially recommended for preterm and critically ill infants, the use of PDHM for supplementation in level 1 newborn nurseries and mother–baby units has increased.⁸ Little is known about the practice of supplementation with PDHM for healthy newborns cared for in postpartum units and level 1 nurseries and its impact on lactation after hospital discharge. As PDHM supplementation becomes more common among well and noncritically ill infants, it is important to gain a clearer understanding of its use during the postpartum hospital stay and its potential effects on lactation and breastfeeding after hospital discharge.

Background

Since 1979, the WHO and UNICEF have recommended an alternate source of “human breastmilk,” as the preferred form of infant supplementation when a mother’s own milk (MOM) is unavailable or contraindicated.⁹ In 2012, the AAP recommended that all preterm infants receive human milk and that PDHM be given when the mother’s milk is not available or contraindicated.¹⁰ The Baby Friendly Hospital Initiative (BFHI) was introduced by the WHO and UNICEF in 1991 and was updated in 2018 to improve breastfeeding care for infants in birthing hospitals.¹¹ The BFHI designation is given when hospitals demonstrate adherence to the Ten Steps to Successful Breastfeeding model designed to promote breastfeeding through practices such as parent education, skin-to-skin contact, early breastfeeding, rooming in, and avoiding the unnecessary use of any food or fluid other than breast milk unless medically indicated.¹² Hospitals must also comply with the International Code of Marketing of Breastmilk Substitutes, which discourages the promotion of formula in birth hospitals.¹²

Standardized guidelines and best practices have not been widely established regarding the use of PDHM for noncritically ill infants, which highlights gaps in knowledge about the use of PDHM for supplementation, indications for use, methods of supplementation, and paired strategies to protect a mother’s milk supply.⁸

Two recent systematic reviews were conducted, in which authors studied the use of PDHM in various populations.^13,14 In the first, McCune and Perrin examined the use of PDHM in healthy infants, critically ill and noncritically ill infants, and other nontraditional recipients treated outside typical well-newborn care settings (e.g., adult cancer patients and children after bone marrow transplants).¹³ The authors reviewed 26 studies and, among those focused on healthy infants, found limited and conflicting evidence supporting a relationship between PDHM use and health outcomes.¹³ While some studies found PDHM was associated with increased breastfeeding duration, others found no impact on breastfeeding outcomes.¹³ In the second, McClintock et al. reviewed 11 studies in which the authors investigated the benefits and risks of infant supplementation with PDHM, infant formula (IF), and MOM for late-preterm infants (LPIs) and early-term infants.¹⁴ In two of the included studies, researchers suggested a positive association between the use of PDHM and exclusive breastfeeding at discharge for LPIs and early-term infants.¹⁴ However, in most of the included studies, researchers reported no association or effect on other measured infant health outcomes.¹⁴ These two systematic reviews included studies from the United States and the international community, and the reviewers concluded that more high-quality studies should be completed because of the unclear associations between the use of PDHM and breastfeeding outcomes.^13,14 Neither McClintock et al. nor McCune and Perrin focused solely on the use of PDHM in healthy, noncritically ill infants in the birth hospital setting.^13,14

The use of PDHM among healthy newborns in the United States is increasing.⁸ Our integrative review¹⁵ approach is distinct in that we included exclusively United States-based research to examine practices within the context of domestic policy and culture, and we incorporated both quantitative and qualitative studies to provide a more comprehensive understanding of the use of PDHM for supplementation in the birth hospital. The purpose of this integrative review¹⁵ was to examine the use of PDHM for supplementation in healthy, noncritically ill newborns cared for in postpartum units and level 1 nurseries and to understand how PDHM supplementation affects lactation after hospital discharge. We acknowledge the gendered nature of some terms used throughout this review. We chose terms for consistency and clarity, and our aim is that all lactating persons and families who will provide human milk will be better informed based on the findings presented in this review.

Methods

We used Whittemore and Knafl’s methodology to conduct our integrative review.¹⁵ An integrative review is an approach to synthesize evidence intended to present the current state of the science on a topic with direct applicability to practice and policy, which makes it an ideal method for contribution to nursing science.¹⁵ Whittemore and Knafl described five stages for conducting an integrative review: problem identification, literature search, data evaluation, data analysis, and presentation.¹⁵ The literature review, data evaluation, and data analysis are described below.

Literature search

The first author consulted with a medical librarian (F.C.) at the University of Pennsylvania to develop and refine the search strategies. PubMed, CINAHL (EBSCO), Scopus (Elsevier), Web of Science (Clarivate), Embase (Elsevier), Emcare (OVID), and the Maternity and Infant Care (OVID) databases were searched. Our search included terms referring to healthy, term, or well infant or newborn, PDHM, milk banks, breastfeeding, and breastmilk supplements. Subject headings were added when applicable, and search terms were modified based on the requirements of each database. The search results were filtered by date from 2014 or later and included studies conducted in the United States only to include the most relevant and contemporary practices. The full search strategy is provided in Supplementary Table S1. Search results were uploaded to Covidence, a web-based collaboration software platform that streamlines the production of systematic and other literature reviews.¹⁶ Record screening, source selection, and appraisal were completed by the first author (N.C.) under the guidance of the supervising author, who was the secondary reviewer (D.L.S.).

Inclusion criteria

We included primary reports of qualitative and quantitative studies that examined the use of PDHM in healthy and noncritically ill infants; took place in or described the context of an inpatient mother–baby hospital unit, level 1 newborn nursery, or other setting where usual postpartum and newborn care are performed in the United States; and were written in English. We excluded sources that included infants primarily cared for in the neonatal intensive care unit. No gestational age was used to include or exclude participants, as policies regarding postpartum care for infants by gestational age vary among hospitals.

Study selection

An initial search was conducted in August 2024, and a secondary search was conducted in October 2025. Search yields from the October 2025 search are indicated heretofore in parentheses.

During the initial search in August 2024, we retrieved a total of 1,776 (+276) records from the database search. We removed 841 (+77) duplicates and screened the remaining 935 (+199) titles and abstracts based on our inclusion criteria. We excluded 885 (+190) records. Of the 50 (+9) remaining studies assessed for eligibility by full-text review, 34 (+7) studies were excluded. Studies were excluded due to the following reasons: unavailability of the full text or abstract only (n = 13) (+3), conducted outside of the United States (n = 5), using the wrong patient population (n = 4) (+1), wrong study design (n = 4) (+2), wrong intervention (n = 2), wrong setting (n = 2), and wrong outcomes (n = 2) (+1). The two aforementioned systematic reviews on the use of donor milk in populations other than critically ill infants^13,14 were included in the search yield. We excluded these sources from our sample of included studies, but we used them to provide background and context in other areas of this article. Both systematic reviews were cross-referenced for additional articles. No additional articles were added. However, nine common articles included in the McCune and Perrin (2021) review^17–25 and five common articles included in the McClintock (2024) review^23–27 had already been selected from the original literature search. Our final review included 18 primary studies.^17–34 The complete search and selection process is shown in a flow diagram using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline³⁵ in Figure 1.

FIG. 1.

PRISMA flow diagram. PRISMA outlines the initial and secondary literature search. Initial search conducted in August 2024, results indicated by first value; secondary search results, conducted in October 2025, indicated by second value.

Data evaluation

Joanna Briggs Institute (JBI) (2024) critical appraisal tools were used to assess the quality of evidence for each study based on its design.^36–39 The JBI appraisal tool lists items to assess the methodological quality and risk of bias based on study design, and each criterion is evaluated by answering “yes,” “no,” “unclear,” or “not applicable.”^36–39 The quality of evidence was scored based on how many “no” or “unclear” responses were elicited, and the study’s quality was rated as “very high” if no items identified a risk of bias, “high” if one or two items identified a risk of bias, “moderate” if three or four items identified a risk of bias, “low” if five or six items identified a risk of bias, and “very low” if seven or more items identified a risk of bias (see Supplementary Table S2).^36–39

Data analysis

We used the data analysis strategy described by Whittemore and Knafl, which included data reduction, data display, data comparison, conclusion drawing, and verification.¹⁵ Common characteristics and broad concepts were categorized and quantified. Codes were inductively generated based on recurring patterns identified across the primary sources. In addition, the provision of the protection of a mother’s milk supply was deductively coded, as evidenced by pumping recommendation, lactation education, or IBCLC (internationally board-certified lactation consultant) consultation. Data collected within each category were compared across sources, integrated, and narratively presented.

Results

Study characteristics

Study designs included three interventional single-site studies,^19,22,33 three survey-based cohort studies,^24,26,27 five multisite survey-based studies,^{17,29–31,33} four retrospective case-control or cohort studies,^23,25,28,32 two qualitative studies,^18,21 and a single case report.²⁰

All studies were based on data collected in the hospital setting. Most studies were completed in hospitals based in the northeastern United States.^{17–19,25–27,30,33} Four studies were completed in Iowa,^20–22,28 one study was set in the Pacific Northwest,³² one study was set in Oklahoma,²³ one study was set in Florida,²⁴ and three studies surveyed hospitals across the country.^29,31,34

Among the 18 studies included in the review, some repetition in authorship was noted. Five studies were authored by Kair,^{20–22,28,31} and two were authored by Ferrarello.^18,19 Common authors were also noted within four studies based in the northeastern United States.^17,25,27,30 Despite common authorship, different samples, variables, methods, and analyses were used. See Table 1 for a summary of the included studies.

Table 1.

Summary of Included Studies

First author/year	Participants (N), setting/dates	Study summary
Interventional studies
Kair, 2019²²	Healthy term breastfeeding dyads newborn >37 weeks GA with weight loss in the first 36 hours and their mothers, N = 60 Suburban academic medical center in Iowa, 8/2014–6/2016	Intervention group: An RCT, given 10 mL PDHM after each breastfeeding session, discontinued until copious milk production. Discharged with PDHM for home use if no copious onset of milk production Control group: Exclusively breastfeeding, unless otherwise directed by HCP. Mothers were assessed daily for milk supply and given a breastmilk storage cooler at discharge Main findings: PDHM supplementation showed no statistically significant impact on feeding type at 1 week, 1, 2, or 3 months post-discharge
Ferrarello, Schumacher, 2019¹⁹	Healthy dyads with NH and intention to exclusively breastfeed in the mother–baby unit, N = 83 An urban academic medical center in Philadelphia, PA, 4-month intervention (dates not stated)	Intervention: PDHM offered to hypoglycemic newborns requiring supplementation Main findings: PDHM accepted by 76% of eligible infants, 98% of eligible infants were still breastfeeding at hospital discharge regardless of supplementation type Hospital exclusive breastfeeding rates increased from 55% to 63.8% by the end of the trial, as PDHM use was included for infants to be considered exclusively breast-feeding
Romano-Clark, 2025³²	Clinical providers in a single-site level 1 newborn nursery University hospital with 3,800 deliveries per year, 4/2023–9/2024	Intervention: Provider survey to identify factors leading to PDHM underuse. The interventions related to those factors were implemented and staff received education Main findings: PDHM use increased during the intervention period compared with preintervention retrospective data. PDHM use for supplementation increased by 70% in healthy infants. In addition, 54% of a subset of those infants were still exclusively breastfeeding at 2 months of age
Survey-based cohort studies
Gray, 2023²⁶	Parents with infants born ≥35 weeks. GA admitted to the newborn nursery with the intention to exclusively breastfeed, N = 1,111 Cohort 1: Pre-PDHM group (n = 271) (June–December 2016) Cohort 2: Post-PDHM group (n = 840) (December 2016–June 2018) Rural Academic Hospital in Vermont	Intervention: Participants were grouped by type of supplementation. Surveys were sent asking about breastfeeding outcomes when infants were 2 and 6 months old Main findings: Infants who supplemented with PDHM or formula had decreased breastfeeding at 2 and 6 months compared with the exclusively breastfeeding groups For infants who received formula compared with PDHM, the odds of breastfeeding at 2 and 6 months were 74% and 58% lower, respectively The PDHM group had lower odds of breastfeeding at both follow-up times compared with the MOM group
Merjaneh, 2020²⁴	Participants: Infants admitted to level 1 nursey with mothers who stated an intention to exclusively breastfeeding and the need for supplementation due to medical indication, N = 72 Setting/Dates: Level 1 nursery at the University of Florida Jacksonville, 6/2015–10/2016	Intervention: A retrospective chart review and follow-up survey phone call to mothers who delivered prior to and after PDHM implementation was completed. Surveys measured duration and exclusivity of breastfeeding, timing of introduction of complementary foods and WIC participation status Main findings: Reasons for supplementation were hypoglycemia, hyperbilirubinemia, and >8% weight loss at 40 hours of life The rate of exclusive breastfeeding at discharge increased from 33% in the pre-PDHM group to 46% in the post-PDHM (p < 0.005). When adjusting for WIC and delivery type, newborns who had donor milk had 5 times greater odds of exclusively breastfeeding at 6 months of life. PDHM for supplementation was associated with a significant increase in exclusive breastfeeding at 6 months
Riley, 2021²⁷	Participants: Healthy dyads with intent to exclusively breastfeed. Infants were healthy, singleton infants >36 weeks GA who required nutritional supplementation, N = 39 A 60-bed postpartum unit in a large academic urban tertiary care hospital in the northeastern United States, 12/2016−10/2017	Intervention: A survey administered to determine relationships between supplementation choice and mother–infant dyad characteristics during the postpartum hospitalization and a 1 month postpartum Main findings: Dyads using formula during the postpartum hospitalization were more likely to have elevated BMI (58% versus 20%, p = 0.02), less likely to have attained greater than a college degree (33% versus 7%, p = 0.02), and had lower breastfeeding intent scores compared with the PDHM group At 1 month, those who supplemented with formula were more likely to continue to provide breast milk to their infants (84% versus 72%), and rates of direct breastfeeding were similar (72% versus 68%). Those who used PDHM supplementation were 1.5 times more likely to provide maternal exclusive BM at 1 month postpartum
Multisite survey-based studies
Belfort, 2018¹⁷	(1) Birth hospitals in Massachusetts (MA) and (2) birth hospitals served by a northeastern U.S. milk bank (Mother’s Milk Bank Northeast), N = 71 11 states and the District of Columbia were represented, 1/2017–3/2017	Intervention: Surveys requested information about (1) hospital characteristics (highest level of neonatal care, BFHI status and exclusive breastfeeding status), (2) PDHM utilization, year PDHM use was initiated, criteria for use and payment, and (3) clinician knowledge and opinions about donor milk Main findings: PDHM was used for healthy newborns by 29% of MA hospitals and 43% of milk bank hospitals. Hospitals using PDHM for healthy newborns had higher exclusive breastfeeding at hospital discharge than hospitals that did not (77% versus 56%, p = 0.02). PDHM use was viewed as beneficial to healthy newborns and as an effective way to improve the exclusive breastfeeding rate of the hospital
Drouin, 2019³⁰	Hospitals in the northeastern U.S. hospitals with written policies regarding PDHM use, N = 15 northeastern U.S. hospitals, 2017	Intervention: Policies from 15 northeastern U.S. hospitals were collected, and authors reviewed aspects of the policy that related to (1) eligibility criteria for PDHM, (2) how PDHM is used and described, and (3) how lactation is supported Main findings: Criteria for PDHM use were stated by 13 policies, most commonly as a bridge until mother’s supply comes in (73%) or for infant medical conditions (67%) including hypoglycemia, hyperbilirubinemia, and weight loss. Consent for PDHM use and an order of PDHM were required by all hospitals. Education was reported by 73%, yet fewer discharged parents with PDHM (33%) or connected parents with PDHM resources for after discharge (40%). Limited specific lactation support was described
James-Davis, 2025²⁴	Well newborn nurseries within (BORN) Hospitals network in the United States, N = 64 Sample also included NICUs (not included in this review) Dates not stated	Intervention: A survey administered eliciting information about PDHM access and practices Main findings: The majority of surveyed well newborn nurseries had access to PDHM while inpatient, yet practices related to eligibility and discontinuation vary
Kair, 2020³¹	Individual provider representatives from the BORN Hospital Network in the United States, N = 71 10/2017–2/2018	Intervention: A 70-question survey evaluating considerations regarding breastfeeding supplementation was administered Main findings: The most common criteria for supplementation were weight loss ≥10% from birth weight (80% of respondents), as well as timing of onset of milk supply, hyperbilirubinemia, and infant I&O status. Donor milk use in well newborns was reported at 21 hospitals (30%) PDHM was more commonly used in hospitals with higher breastfeeding rates (>81% versus <80%, PDHM available in 44% versus 4%) and was the supplement of choice in these hospitals. Overall provider preference was more favorable for PDHM than for IF
Parker, 2020²⁹	Nursing leaders at birth hospitals randomly selected from four regions across the United States, N = 214 Randomly selected birth hospitals from four regions of the United States, 10/2017–12/2017	Intervention: A survey asked if PDHM is routinely accessible for infants receiving level 1 neonatal care, and questing was based on (1) beliefs about donor milk, (2) hospital characteristics, and (3) donor milk program characteristics (asked of those who reported PDHM use) Main findings: Among respondents, 17.6% report PDHM use routinely in level 1 nurseries. Most (85%) PDHM programs were less than 5 years old and were more common in hospitals with ≥1,500 annual births than in those with ≤500 births, and PDHM was used more often in the west than in the northeast region
Retrospective case-control/cohort studies
Kair, 2020²⁸	Mother–infant dyads the well newborn/postpartum unit between 1/2014 and 12/2014 who were supplemented with IF or PDHM, N = 678 dyads Iowa, 2015–2018	Intervention: A retrospective chart review and data analysis to evaluate relationships between type of supplementation used (PDHM or IF) and maternal characteristics Main findings: IF supplementation was used by 372 mother–infant dyads, and 306 were supplemented with PDHM. Lower rates of PDHM use were noted among non-White women, those who were non-English-speaking and those with private insurance
McKittrick, 2020³²	Mother–infant dyads in the mother–baby unit in which infants were ≥37 weeks’ GA, mothers expressed an intention to breastfeeding, and ≥1 supplemental feeding for indications other than NH was given, N = 584 Academic medical center in the Pacific Northwest, 3/2017−4/2019	Intervention: A retrospective chart review was done to evaluate relationships between supplementation type and practices and maternal and infant characteristics (maternal age, ethnicity, race, language, insurance type, parity, delivery method, infant birth weight, gestational age, if supplement was given within 12 hours, time of first supplement, phototherapy, NICU transfer, and 30-day readmission) Main findings: In the final cohort of 584 dyads, PDHM was used less often than formula (42.3% versus 57.7%). Infants were more likely to get PDHM if supplemented during dayshift versus nightshift, if being treated for hyperbilirubinemia, and if born via cesarean. Dyads with private insurance and those who were English-speaking and identified as White or non-Hispanic were more likely to receive PDHM for supplementation
Mannel, 2018²³	LPIs ages 35 0/7–36 6/7 weeks admitted into a mother–baby unit, N = 183 A tertiary care teaching hospital in Oklahoma, 11/1/2014–10/31/2016	Intervention: A retrospective chart review completed to determine the type of supplementation fed to LPIs on the mother–baby unit, and if there was any association between supplementation type and LOS, as well as breastfeeding status at discharge Main findings: LOS for LPIs supplemented with mother’s expressed milk or PDHM was similar to those exclusively breastfeeding. LOS was longer for exclusively IF fed infants (3.2 days) compared with exclusively breastfeeding infants (2.6 days). LPIs who were breastfeeding and supplemented with formula were 16% less likely to be breastfeeding at time of discharge than those supplemented with MOM or PDHM
Sen, 2018²⁵	Mothers and infants discharged from the well-baby nursery who received PDHM between 7/2013 and 6/2016, N = 503 Brigham and Women’s Hospital, Boston, MA, 7/2013–6/2016	Intervention: A retrospective chart review to evaluate trends and associations between infants who received PDHM and infant and maternal characteristics (243 mothers and 260 infants). Maternal and infant demographic and clinical information were collected, including the number of infants given PDHM, the quantity of PDHM provided, and indications for use Main findings: The use of PDHM in healthy infants increased during the study period, with increases corresponding with two grants to purchase PDHM. The average volume of PDHM also increased 0.6 bottles per infant to 4.6 bottles per infant. The most common indications were excessive weight loss, parent/caregiver request, late preterm birth, poor latch and excessive weight loss
Qualitative studies
Ferrarello, Froh 2019¹⁸	RNs working in the labor and delivery unit or the mother–baby unit, N = 20 A large Philadelphia hospital, dates not stated	Intervention: A total of six focus groups of three or four RNs were conducted over a 2-month period that lasted about 20–30 minutes and were completed on the labor and delivery unit or mother–baby unit. With the use of an interview guide, RNs were asked about their thoughts and experiences about use of PDHM supplementation for term infants with hypoglycemia in the first hours or day of life Main findings: (1) nurses’ presumed safety of PDHM but lack of knowledge, (2) nurses see their role as patient and family advocate, (3) logistical concerns about implementation of PDHM, and (4) nurses lacked clarity related to informal milk sharing versus PDHM
Kair, 2017²¹	Postpartum mothers of healthy newborns who breastfed and gave supplementary feedings with PDHM and/or IF during the birth hospitalization, n = 30 The mother–baby unit at the University of Iowa Hospitals and Clinics, an academic medical center in Iowa City, Iowa, 9/2015–6/2016	Intervention: Semistructured interviews were conducted with postpartum mothers to gain an understanding of why mothers of well newborns chose to supplement their infants with donor milk or formula Main findings: Supplementary feedings using donor milk were used by 13 (43%) of mothers, 15 (50%) used formula only, and 2 (7%) used both donor milk and formula. Donor milk is seen as temporary, whereas formula is seen as an ongoing plan; (b) formula is viewed as familiar, whereas donor milk is viewed as unfamiliar; (c) donor milk is costly and challenging logistically; and (d) donor milk is “healthier.”
Case reports
Kair, 2014²⁰	Exemplar cases of PDHM use in healthy newborns, N = 2 University of Iowa Children’s Hospital newborn nursery, dates not stated	Case 1: A term infant who was SGA had meconium-stained amniotic fluid and bradycardia and respiratory distress after delivery. Mother had chorioamnionitis Case 2: A LPI with respiratory distress after delivery, complicated by a mother with T1DM, was supplemented due to latch difficulty. Both infants temporarily went to the transitional nursery and then roomed in with mother Case 1: The infant was discharged home without a PDHM prescription and was exclusively breastfeeding at his 2-week well-child examination Case 2: The infant was discharged home with PDHM, and was exclusively breastfeeding at 1 week after discharge, primarily with his mother’s pumped milk, and his mother was working with an IBCLC to address latch concerns

BFHI, Baby-Friendly Hospital Initiative; BMI, body mass index; BORN, better outcomes through research for newborns; GA, gestational age; I&O, intake and output; IBCLC, Internationally Board Certified Lactation Consultant; IF, infant formula; LOS, length of stay; LPI, late-preterm infant; MOM, mothers’ own milk; NH, neonatal hypoglycemia; NICU, neonatal intensive care unit; PDHM, pasteurized donor human milk; RCT, randomized controlled trial; RN, registered nurses; T1DM, type 1 diabetes mellitus; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.

Quality of evidence

The 18 included studies were appraised using the JBI critical appraisal tools (2024) based on their study design.^36–39 Two articles were rated to be of very high quality,^18,23 12 were rated as high quality,^{19–22,24–26,29,31–34} and 4 were rated as moderate quality.^17,27,28,30 No studies were rated as low or very low quality. See detailed quality assessment data in the Supplementary Table S2.

Indications for supplementation

Among the 18 studies, 15 (83%) included specific indications for supplementation.^{17–21,23–26,29–34} Neonatal hypoglycemia, hyperbilirubinemia, and weight loss were the most frequent indications for PDHM supplementation.^{18–21,23–26,29–34} Delayed lactation or lactation problems,^30,31,33 feeding difficulties,^{22,23,25,26,33,34} and gestational age or birth weight criteria^17,23,29,30 were also frequently mentioned indications for supplementation of healthy infants with PDHM.

LPIs were specifically identified as a population at higher risk for indications for supplementation by seven studies.^{17,21,23,25,29–31} LPIs were either not defined^21,29–31 or defined as 35–36 weeks^17,23 or 35–37 weeks.²⁵ Mannel and Peck found that while most mothers of LPIs in their study initiated breastfeeding, 80.7% of these infants received some supplementation during the birth hospitalization, with the most frequent reason being maternal request, followed by physician order (not otherwise specified).²³

Parental request was another common indication for supplementation with PDHM.^21,^{22,23,25,26,29,32–34} Kair and Flahermanfound that the most common maternal self-reported reasons for PDHM or IF supplementation were low milk supply, difficulty latching, and maternal preference.²²

Hospital-level characteristics

Five studies sent surveys to hospitals in the United States to assess the use of PDHM in well newborn nurseries.^{17,29–31,34} The number of respondents from multisite surveys varied from n = 15 to n = 214.^29,30 Kair et al. found that hospitals with higher breastfeeding rates (>81% versus <80%) were more likely to have PDHM available for healthy infants (44% versus 4%).³¹ Belfort et al. reported that hospitals using PDHM for healthy newborns had higher rates of exclusive breastfeeding at discharge.¹⁷ Parker et al. reported that most donor milk programs in level 1 nurseries were less than 5 years old and were more common in hospitals with greater than 1,500 births per year.²⁹ However, James-Davis et al. surveyed 64 well newborn nurseries across the United States and found no association between yearly newborn admissions and access to PDHM.³⁴ Parker et al. found that PDHM programs for healthy infants were more frequently available in hospitals located in the West and Midwest compared with the northeastern and southern regions of the United States.²⁹ Similarly, James-Davis et al. reported a decreased availability in the northeastern United States compared with other regions in their more recent study.³⁴

Five studies included in this review describe hospitals that have a written policy for PDHM use,^{17,19,20,30,34} five studies describe hospitals where signed consent is required for PDHM use,^{17,19,27,29,30} and nine studies describe an order being required for the use of PDHM, typically written by a physician or advanced practice provider.^{17,19,29,30,34} James-Davis et al. found that among 64 well newborn nurseries surveyed, 32 (58%) hospitals had a policy in place for PDHM provision, yet only 22 (40%) had a policy in place for discontinuation of PDHM.³⁴ McKittrick et al. found that infants receiving their first supplemental feeding during the day shift were twice as likely to receive PDHM over formula than if the first supplemental feeding was given on the night shift.³²

Drouin et al. examined 15 policies regarding PDHM use from U.S. hospitals and found that while lactation-focused patient education was reported in the PDHM policy by 11 (73%) of hospitals, it was not specifically detailed and focused mainly on education about breastmilk, breastfeeding, and PDHM.³⁰ Few hospitals routinely discharged patients with PDHM (33%) or connected parents with local resources to obtain PDHM after discharge (40%).³⁰

Ferrarello et al. described a nurse-led trial initiative with a written guideline to provide PDHM to well newborns with hypoglycemia which was defined as “a blood glucose level of less than 45 mg/dl in the first 4 hours of life, less than 50 mg/dl between 4 hours and 48 hours, and less than 60 mg/dl after 48 hours.”¹⁹, p.321. The authors found that the majority of mothers in their study chose PDHM as a supplement for their infant, and hospital breastfeeding rates increased during the trial period.¹⁹ Sen et al. examined PDHM use in healthy infants with a retrospective chart review and found that an increase in PDHM use, as well as an increase in the volume of PDHM used, corresponded to the obtainment of two grants designated to purchase PDHM.²⁵

Nine studies were set in or included hospitals that had received BFHI designation or were on the pathway to BFHI designation.^{17,19,23,27,29,31–34} No direct association between BFHI hospitals and PDHM use, or breastfeeding outcomes, was measured.

Breastfeeding outcomes

Nine studies included data about breastfeeding outcomes, specifically breastfeeding rates at or after discharge, among well infants cared for in the postpartum unit or newborn nursery who used PDHM for supplementation.^{17,19,20,22–24,26,27,33} Kair et al. conducted a randomized controlled trial (RCT) in which a small volume of PDHM supplementation was administered after breastfeeding sessions in the intervention group until the mature milk supply was established, yet investigators found no association with PDHM supplementation and breastfeeding rates at 1 week or at 1, 2, or 3 months postpartum.²² Investigators also found that at the 3-month follow-up time point, the prevalence of directly feeding at the breast within the last 24 hours was lower in the intervention group compared with the control group.²²

Eight studies support a positive association between PDHM use for supplementation and improved breastfeeding outcomes.^{17,19,20,23,24,26,27,33} Supplementation with expressed MOM resulted in similar or higher breastfeeding rates than PDHM for supplementation in four studies.^23,24,26,27 Gray et al. found that infants supplemented with formula were 74% less likely to breastfeed at 2 months and 58% less likely to breastfeed at 6 months compared with those supplemented with PDHM; however, infants who supplemented with PDHM had lower odds of breastfeeding at 2 and 6 months compared with those who supplemented with MOM.²⁶ Merjaneh et al. found that using PDHM for supplementation among mothers who expressed an intention to breastfeed was associated with a significantly increased likelihood of exclusively breastfeeding at 6 months compared with those who supplemented with IF.²⁴ Belfort et al. found that hospitals that offer donor milk to healthy infants had higher rates of exclusive breastfeeding at discharge compared with hospitals that do not.¹⁷

Maternal and infant characteristics associated with PDHM use

Mother–infant dyads were more likely to use PDHM for supplementation if the mother identified as White,^27,28,32,33 was primarily English-speaking,^27,28,32,33 or had private insurance.^28,32 Kair et al. and McKittrick et al. both conducted retrospective reviews and hypothesized that disparities in PDHM use may be influenced by institutional barriers, language barriers, health care provider bias, and personal or family experiences.^28,32 Kair et al. found that in a national survey of hospitals, Hispanic women were 72% less likely to use PDHM than non-Hispanic White women.²⁸ Non-Hispanic White women were also more likely to use PDHM when compared with non-Hispanic Black and Asian women, as well as those who reported their race as “other.”²⁸

Lower education levels²⁷ and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children were associated with more formula use.^24,27 Riley et al. found that infants in one urban tertiary care hospital were more likely to be supplemented with formula if they were born to mothers with an elevated body mass index (BMI) and those who had obtained less than a college degree.²⁷

Opinions on the use of PDHM

Clinical opinion

Five studies included data regarding clinician or patient opinions and acceptance of the use of PDHM supplementation in healthy infants.^{17,18,22,31,33} Opinions among physicians and ordering clinicians were generally positive regarding the use of PDHM.^17,18,31 Both providers and nurses viewed PDHM as healthy when compared with formula.^17,18,29,31 In a national survey, Kair et al. found that 62% of providers felt “very positive” or “somewhat positive” about the use of PDHM in healthy and noncritically ill infants outside the NICU and expressed a preference for PDHM supplementation over formula.³¹ Romano-Clarke et al. created a quality improvement initiative to improve provider education about PDHM and found an increased acceptance and use of PDHM in their well newborn nursery.³³ Belfort et al. found that while the majority of the providers surveyed (n = 66) agreed that PDHM showed health benefits for LPIs (n = 56, 88%) and healthy newborns (n = 51, 78%), fewer providers felt that PDHM use in the well-baby nursery would be accepted by parents (n = 25, 38%), nurses (n = 25, 38%), and pediatricians (n = 26, 39%).¹⁷

Maternal opinion

Kair and Flaherman surveyed mothers on the use of PDHM for supplementation and found most mothers viewed PDHM as “healthy” and “temporary,” yet many had concerns that it was “unfamiliar” compared with formula and worried it would be “costly” or “logistically challenging” to obtain after discharge.²¹ In comparison, supplementation with IF was more often regarded as a long-term plan.²¹ Two mothers viewed PDHM supplementation as “weird,” and one mother said, “I don’t feel comfortable with having someone else’s bodily fluids going into my child.”²¹, p.713.

When given the option, Ferrarello et al. found that a majority of mothers chose to use PDHM (n = 63) over formula (n = 20) for supplementation in the case of neonatal hypoglycemia.¹⁹ Comments from parents in this study were positive, with mothers stating, “Mother’s or human milk is best,” and “If I would know who the mother that donated this milk is, I would like to thank her.”¹⁹, p. 324.

Protection of milk supply

Measures to protect maternal milk supply were mentioned in 13 of the 18 studies.^{18–22,24,26–28,30,31,33,34} In the single RCT, Kair et al. stopped all supplementation in the intervention group once copious milk supply came in.²² Lactation education was reported to be provided by IBCLCs or nurses in 10 studies.^{19–21,24,26–28,30,31,33} A formal lactation consultation as a standard of care with the use of PDHM for supplementation was reported in five studies.^{19–21,26,31}

Pumping was specifically recommended for mothers using PDHM in three studies.^27,28,34 In addition, Kair et al. reported that both mothers were pumping before or after discharge in their case report.²⁰ Kair et al. (2020) reported that, in a national survey of 71 hospitals, only 76% (n = 54) of respondents reported pumping recommendations for women who were supplementing their infants.³¹ James-Davis et al. found that 74% of the 64 well newborn nurseries surveyed did not require parents to actively pump or express milk during their birth hospitalization.³⁴

While access to PDHM at discharge may provide exclusivity of a human milk diet, this alone does not account for measures to help protect milk supply. Obtaining PDHM after discharge was mentioned in two studies and one case report.^20,22,30 Kair et al. described cases where patients were discharged with PDHM or arrangements to obtain PDHM after hospital discharge were made.²⁰ Kair et al. supplied PDHM at discharge to mothers in the intervention group who did not report copious milk supply by the time of discharge.²² Gray et al. described that in a rural academic hospital in Vermont, due to logistical constraints of obtaining PDHM outpatient, infants are routinely transitioned to formula supplementation just before discharge if supplementation is required.²⁶

Discussion

With this review, we highlight current practices, opinions, and potential benefits and shortcomings of PDHM supplementation in healthy and noncritically ill newborns. The use of PDHM for supplementation, when necessary or recommended, is a growing option in birth hospitals across the United States. Common diagnoses in healthy and noncritically ill newborns that require supplementation, such as neonatal hypoglycemia, hyperbilirubinemia, and weight loss, are frequently managed in mother–baby and postpartum units.⁴⁰ These conditions are typically transient and may only necessitate temporary supplementation before hospital discharge.

LPIs are a population in which PDHM may be specifically important. LPIs are often cared for in well-baby areas, and their specific needs can be easily overlooked.⁴¹ LPIs have lower breastfeeding rates than their term counterparts and have a higher likelihood of the need for supplementation, driven by their immaturity, which can be associated with ineffective milk removal and delayed onset of lactation.⁴ Supplementing with PDHM instead of formula may be protective of breastfeeding for this population, promoting health benefits that are particularly important for this higher-risk group.⁴

Any supplementation in the early postpartum period, regardless of type, can interfere with secretory activation.^7,42 Women whose infants receive supplementation should be proactively managed to maximize milk supply and promote the onset and maintenance of secretory activation, both in the inpatient and outpatient settings.⁴² The protection of milk supply during PDHM supplementation was described by 13 out of 18 articles (72%) included in this review.^{18–22,30,31,33,34} The provision of lactation education to families by nurses or IBCLCs may help ensure that families are well equipped to continue stimulating milk supply while their infant is being supplemented.

Hospitals with policies or guidelines aimed toward supporting breastfeeding may contribute to consistency in care delivered to breastfeeding families supplementing with PDHM, which reinforces current evidence.⁴³ Consent for the use of PDHM for supplementation was frequently described and implies that PDHM is viewed similarly to medications or other biospecimens. The informed consent time point also presents an additional opportunity for education and clarification in managing milk supply while supplementing.

Nine of the studies included hospitals with, or on the pathway to, BFHI designation.^{17,19,23,27,29,31–34} Seeking or having obtained BFHI status may reflect a priority toward the use of human milk. These hospitals may nurture a supportive breastfeeding culture in multiple ways in addition to the use of PDHM. While BFHI supports PDHM use for supplementation over IF, the availability of PDHM is not required for BFHI designation.¹²

Volumes of PDHM supplied were only mentioned in one study,²⁵ and reassessment and discontinuation criteria for PDHM were infrequently outlined in hospital policies.^30,34 Ongoing, early supplementation is an important factor in developing the mother’s milk supply and future breastfeeding, and the necessity should be carefully evaluated to support appropriate supplementation practices.

Pumping recommendations were infrequently described in policies and practices when supplementing with PDHM.^27,30,31,34 In the single case report, Kair et al. described that both families initiated pumping at the birth hospital, yet did not specify if this was a standard of care.²⁰ All patients who use PDHM for supplementation after birth should have a proactive pumping plan during their inpatient hospitalization, before hospital discharge, and during early outpatient management based on their short- and long-term breastfeeding goals.

Only three studies^22,30,34 and one case study²⁰ mentioned discharging families with PDHM or arranging for obtaining outpatient PDHM. Kair et al. incorporated a small supply of PDHM given at discharge to certain mothers into the intervention arm of their RCT.²² Alternatively, Gray et al. describe that due to logistic constraints of obtaining PDHM outpatient, infants who need continued supplementation are routinely transitioned to IF before discharge, interrupting exclusive human milk feeding.²⁶ To facilitate the transition to home feeding, clinicians should be aware of PDHM availability outside of the hospital and discuss feeding plans and expectations with families. Discussions with families based on short- and long-term breastfeeding goals can inform an individualized lactation management plan upon discharge.⁴

Although it is beyond the scope of this review, the practice of informal milk sharing should be acknowledged. Informal milk sharing involves feeding an infant human milk obtained from a donor found within the community or via the internet and carries risks, including exposure to medications, diseases, or contaminants.⁴⁴ While the AAP discourages informal milk sharing, clinicians must be aware of and screen for this practice and can advise recipients to ensure that the donor is medically screened and the milk is handled properly.^4,44

Generally, physicians and nurses had positive opinions about PDHM as an option for infant supplementation.^17,18,31 The presence of guidelines and policies might help clinicians advocate for the use of PDHM for supplementation and create more familiarity with its use and potential benefits. Parents generally felt positive toward PDHM use, though some felt it was “unfamiliar” or “weird.”²¹ Interestingly, Kair and Flaherman found supplementation with PDHM was commonly perceived as a temporary bridge to overcome the early hurdles of breastfeeding, yet IF was viewed as a more permanent feeding substitute.²¹ Insights into the motivations and rationales for choosing PDHM or IF for supplementation will help guide the development of best practices, education for parents and clinicians, and hospital policies and guidelines that center on the feeding goals of the individual family.

An increased association between PDHM supplementation and improved breastfeeding rates was demonstrated by several studies.^{19,20,23,24,26,27} Parental intention and motivation to breastfeed, lack of exposure to or comfort with formula, or other factors likely play a role in the choice to supplement with PDHM and continued breastfeeding. An important note is that many hospitals include PDHM use in their exclusive breastfeeding rates, so some infants who are said to be exclusively breastfeeding were supplemented with PDHM, and not exclusively receiving MOM. This may inflate a hospital’s exclusive breastfeeding rates at discharge due to the use of PDHM supplementation.

Differences were described in PDHM supplementation based on race, ethnicity, primary language, insurance type, education levels, and BMI.^27,28,32,34 The racial and socioeconomic trends demonstrated in this review mirror the larger racial and socioeconomic inequities in overall breastfeeding and maternity care in the United States.⁴ Overall, breastfeeding initiation rates in the United States vary by race, with Black mothers initiating breastfeeding up to 16.7% less often than other ethnicities, based on 2019 National Vital Statistics System birth certificate data.⁴⁵ Similarly, Isiguzo et al. examined the impact of stress, support, and race on exclusive breastfeeding and found that, in general, Black mothers were less likely to exclusively breastfeed when compared with White mothers.⁴⁶

While supplementation choice may be multifactorial, findings associated with demographic characteristics suggest that certain groups may be less likely to be offered PDHM for supplementation, particularly those who identify as non-White, are non-English-speaking, and have lower socioeconomic status. Clinicians should be aware of the possibility of implicit or explicit biases affecting the supplementation choices offered to parents. All parents deserve accurate and complete information to be able to make informed and realistic feeding choices, and awareness of current trends will help clinicians partner with parents to achieve their personal feeding goals.

Limitations

We only included studies conducted within the United States, which limits the relevance of the findings for other countries. Furthermore, half of the studies in this review were conducted in the northeastern United States, which may limit generalizability.

Eleven of the 18 included studies had common authors, which may skew the findings based on researcher bias and a limited participant pool. It is possible that some data may have been analyzed and included more than once. The relatively small group of authors that contributed to this review is a limitation of this study; however, it reflects that the topic of PDHM use in healthy and noncritically ill infants is a growing field of research.

Conclusions

Practices surrounding PDHM supplementation for healthy infants vary, and the evidence about the effect on breastfeeding is mixed. While some findings support an association between PDHM supplementation with better breastfeeding outcomes compared with IF, these associations are likely multifactorial. Moreover, the availability of PDHM for supplementation aligns with and supports the feeding intentions of mothers who aim to provide human milk for their infants.

PDHM use should be thoughtfully considered and used in combination with other practices that are supportive of exclusive and prolonged breastfeeding. Hospital policies and practices that outline measures to equitably and proactively support lactation during PDHM supplementation may enhance breastfeeding and optimize the use of PDHM as a tool to improve breastfeeding outcomes. Further research is needed to determine best practices for PDHM supplementation in healthy infant populations and to explore the experiences of mothers whose infants were supplemented and the effect of PDHM supplementation on feeding after hospital discharge.

Authors’ Contributions

N.C.: Conceptualization, methodology, formal analysis, writing—original draft, and writing—review and editing. D.L.S.: Conceptualization, methodology, review of analysis, writing—review and editing, and supervision.

Footnotes

Acknowledgments

Librarian assistance and review of the qualifying examination by faculty at the University of Pennsylvania School of Nursing.

Disclosure Statement

The authors have no conflicts of interest to disclose.

Funding Information

No funding was received for this research.

Supplemental Material

References

1.World Health Organization & UNICEF. 2020. Global breastfeeding collective: A call to action. Available from: https://www.globalbreastfeedingcollective.org/media/551/file

2. Meek

, Noble

, Section on B. Policy statement: Breastfeeding and the use of human milk. Pediatrics 2022;150(1):e2022057988.

3.Centers for Disease Control and Prevention. 2025. CDC’s early childhood nutrition report 2025. Available from: https://www.cdc.gov/nutrition/media/pdfs/2025/CDC-Early-Childhood-Nutrition-Report-National-2025-508.pdf [Last accessed: Nov 19, 2025].

4. Meek

, Noble

. Technical report: Breastfeeding and the use of human milk. Pediatrics 2022;150(1):e2022057989.

5. McGowan

, Bland

. The benefits of breastfeeding on child intelligence, behavior, and executive function: A review of recent evidence. Breastfeed Med 2023;18(3):172–187.

6. Brownell

, Howard

, Lawrence

, et al. Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatr 2012;161(4):608–614.

7. Spatz

, Rodriguez

, Benjilany

, et al. Having enough milk to sustain a lactation journey: A call to action. Nurs Womens Health 2024;28(4):256–263.

8. Awan

, O’Connor

, Kortsmit

, et al. Changes in donor human milk use among US Hospitals: 2018–2024. Pediatrics 2025;156(2):e2024069469.

9. Unicef

. WHO/UNICEF meeting on infant and young child feeding. Journal of Nurse Midwifery 1980;25(3):31–39; doi: 10.1016/0091-2182(80)90051-8

10.

10.Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012;129(3):e827–e841; doi: 10.1542/peds.2011-3552

11.

11.Baby Friendly USA. 2024a. December 27) The Baby Friendly Hospital initiative. Available from: https://www.babyfriendlyusa.org/about/ [Last accessed: Nov1 6, 2025].

12.

12.Baby Friendly USA. 2024b. December 27) Baby Friendly USA–10 steps & international code. Available from: https://www.babyfriendlyusa.org/for-facilities/practice-guidelines/10-steps-and-international-code/ [Last accessed: Nov1 6, 2025].

13.

13. McCune

, Perrin

. Donor human milk use in populations other than the preterm infant: A systematic scoping review. Breastfeed Med 2021;16(1):8–20.

14.

14. McClintock

, Fiddes

, Harris

, et al. Donor human milk versus infant formula for low-risk infants: A systematic review. Pediatr Res 2025;97(1):81–91.

15.

15. Whittemore

, Knafl

. The integrative review: Updated methodology. J Adv Nurs 2005;52(5):546–553.

16.

16.Covidence systematic review software. 2024. Veritas Health Innovation, Melbourne, Australia. Available from: www.covidence.org

17.

17. Belfort

, Drouin

, Riley

, et al. Prevalence and trends in donor milk use in the Well-Baby Nursery: A survey of Northeast United States Birth Hospitals. Breastfeed Med 2018;13(1):34–41.

18.

18. Ferrarello

, Froh

, Hinson

, et al. Nurses’ views on using pasteurized donor human milk for hypoglycemic term infants. MCN Am J Matern Child Nurs 2019;44(3):157–163.

19.

19. Ferrarello

, Schumacher

, Anca

. Nurse-driven initiative to increase exclusive human milk feeding by using pasteurized donor human milk to treat hypoglycemic term neonates. Nurs Womens Health 2019;23(4):316–326.

20.

20. Kair

, Colaizy

, Hubbard

, et al. Donor milk in the newborn nursery at the University of Iowa Children’s Hospital. Breastfeed Med 2014;9(10):547–550.

21.

21. Kair

, Flaherman

. Donor milk or formula: A qualitative study of postpartum mothers of healthy newborns. J Hum Lact 2017;33(4):710–716.

22.

22. Kair

, Flaherman

, Colaizy

. Effect of donor milk supplementation on breastfeeding outcomes in term newborns: A randomized controlled trial. Clin Pediatr (Phila) 2019;58(5):534–540.

23.

23. Mannel

, Peck

. Outcomes associated with type of milk supplementation among late preterm infants. J Obstet Gynecol Neonatal Nurs 2018;47(4):571–582.

24.

24. Merjaneh

, Williams

, Inman

, et al. The impact on the exclusive breastfeeding rate at 6 months of life of introducing supplementary donor milk into the level 1 newborn nursery. J Perinatol 2020;40(7):1109–1114.

25.

25. Sen

, Benjamin

, Riley

, et al. Donor milk utilization for healthy infants: Experience at a Single Academic Center. Breastfeed Med 2018;13(1):28–33.

26.

26. Gray

, Ryan

, Churchill

, et al. The association between type of supplementation in the newborn nursery and breastfeeding outcomes at 2 and 6 months of age. J Hum Lact 2023;39(2):245–254.

27.

27. Riley

, Cherkerzian

, Benjamin

, et al. Clinical characteristics and breastfeeding outcomes in term Dyads following in-hospital supplementation with pasteurized donor human milk or formula. Breastfeed Med 2021;16(9):717–724.

28.

28. Kair

, Nidey

, Marks

, et al. Disparities in donor human milk supplementation among well newborns. J Hum Lact 2020;36(1):74–80.

29.

29. Parker

, Burnham

, Kerr

, et al. National prevalence of donor milk use among level 1 nurseries. Hosp Pediatr 2020;10(12):1078–1086.

30.

30. Drouin

, Riley

, Benjamin

, et al. Donor milk policies for level 1 newborn care: A descriptive analysis. Breastfeed Med 2019;14(8):592–596.

31.

31. Kair

, Phillipi

, Lloyd-McLennan

, et al. Supplementation practices and donor milk use in US well-newborn nurseries. Hosp Pediatr 2020;10(9):767–773.

32.

32. McKittrick

, Khaki

, Gievers

, et al. Clinical and sociodemographic factors associated with human donor milk supplementation in term newborns. Hosp Pediatr 2020;10(6):489–495.

33.

33. Romano-Clarke

, Jain

, Dey-Lawson

, et al. Increasing pasteurized donor human milk use in a level 1 newborn nursery. Hosp Pediatr 2025;15(9):e422–e430.

34.

34. James-Davis

, Drumm

, Krick

, et al. Examination of donor human milk practices within well newborn nurseries and neonatal intensive care units across the United States. Hosp Pediatr 2025;15(7):616–622.

35.

35. Page

, McKenzie

, Bossuyt

, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71.

36.

36. Barker

, Stone

, Sears

, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evid Synth 2023;21(3):494–506.

37.

37. Moola

, Munn

, Tufanaru

, et al. Chapter 7: Systematic reviews of etiology and risk. In: Aromataris

, Munn

(Editors). JBI Manual for Evidence Synthesis. JBI, 2020. Available from: https://synthesismanual.jbi.global

38.

38. Munn

, Barker

, Moola

, et al. Methodological quality of case series studies: An introduction to the JBI critical appraisal tool. JBI Evid Synth 2020;18(10):2127–2133.

39.

39. Lockwood

, Munn

, Porritt

. Qualitative research synthesis: Methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc 2015;13(3):179–187.

40.

40. Joshi

, Flaherman

, Halpern-Felsher

, et al. Admission and care practices in United States well newborn nurseries. Hosp Pediatr 2023;13(3):208–216.

41.

41. Standish

, Combs

, McMahon

, et al. Early bloomers: A nursing-driven program to support human milk feeding among late preterm infants in the mother-baby unit. J Hum Lact 2024;40(1):96–100.

42.

42. Spatz

, Alvarez Rodriguez

, Benjilany

, et al. Proactive management of lactation in the birth hospital to ensure long-term milk production and sustainable breastfeeding. J Midwifery Womens Health 2025;70(2):343–349.

43.

43. Li

, Song

, Zhang

, et al. Breastfeeding supportive services in baby-friendly hospitals positively influenced exclusive breastfeeding practice at hospitalization discharge and six months postpartum. Int J Environ Res Public Health 2021;18(21):11430.

44.

44. Sriraman

, Evans

, Lawrence

, Academy of Breastfeeding Medicine’s Board of D.et al. Academy of Breastfeeding Medicine’s 2017 position statement on informal breast milk sharing for the term healthy infant. Breastfeed Med 2018;13(1):2–4.

45.

45. Chiang

, Li

, Anstey

, et al. Racial and ethnic disparities in breastfeeding initiation horizontal line United States, 2019. MMWR Morb Mortal Wkly Rep 2021;70(21):769–774.

46.

46. Isiguzo

, Mendez

, Demirci

, et al. Stress, social support, and racial differences: Dominant drivers of exclusive breastfeeding. Matern Child Nutr 2023;19(2):e13459.

Supplementary Material

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The Use of Pasteurized Donor Human Milk in Healthy Newborns and Lactation Outcomes After Hospital Discharge in the United States: An Integrative Review

Abstract

Background:

Methods:

Results:

Conclusions:

Keywords

Introduction

Background

Methods

Literature search

Inclusion criteria

Study selection

Data evaluation

Data analysis

Results

Study characteristics

Quality of evidence

Categories

Indications for supplementation

Hospital-level characteristics

Breastfeeding outcomes

Maternal and infant characteristics associated with PDHM use

Opinions on the use of PDHM

Clinical opinion

Maternal opinion

Protection of milk supply

Discussion

Limitations

Conclusions

Authors’ Contributions

Footnotes

Acknowledgments

Disclosure Statement

Funding Information

Supplemental Material

Supplemental Material

References

Supplementary Material